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Cross Cultural Practices, Cultural Diversity & Ethical Boundaries: Overcoming Barriers to Counseling Effectiveness
Cross Cultural Practices, Cultural Diversity & Ethical Boundaries: Overcoming Barriers to Counseling Effectiveness

Section 6
Cultural Competence in Psychotherapy

Question 6 | Test | Table of Contents
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

Ethics - Acculturative Issues in the Immigrant Family
Counseling immigrant families requires an awareness that family members will acculturate differently (Berry, 1980; Berry & Kim, 1988; Gushue & Sciarra, 1995; Landau-Stanton, 1990; Santiago-Rivera, 1995; Sue & Sue, 1990; Szapocznik, Scopetta, Kurtines, & Aranalde, 1978). Children, who because of greater facility in learning the language and more sustained contact with the dominant culture through school and other activities, generally move toward the host culture more easily than their parents (Baptiste, 1990, 1993; Gopaul-McNicol & Thomas-Presswood, 1998; Kiselica, Changizi, Cureton, & Gridley, 1995). Parents, on the other hand, are more attached to their native culture and may find it difficult at times to understand and appreciate the ways of the host culture. As time goes on, these differences can become minimized as parents integrate slowly into the dominant culture. On the contrary, conflict between parents and children can develop if parents withdraw from the dominant culture and children continue to become more allied with it. Although in need of counseling services due to escalating conflict, many immigrant parents will resist seeking such services because of cultural, social, geographical, and linguistic barriers (Leong, Wagner, & Tara, 1995). However, immigrant families who do seek counseling often present with the previously mentioned acculturative conflict in which parents reinforce the ways of their native culture, whereas the children adopt the ways of the host culture.

Acculturative Issues in the Separated Family
Families in which a parent(s) has preceded the children in the immigrant experience can present a different scenario in terms of acculturation. In these cases, the parent may have already integrated into the dominant culture, whereas the children are less integrated and possibly grieving the loss of their country of origin. Family counselors need to be more sensitive to issues of separation and reconciliation in these families.

It has been my experience that the adaptation process for children sent for by their parents is complex and therefore can be traumatic. First, they must undergo the stress of adapting to the host culture. Although such stress can produce positive and invigorating results, the opposite can also occur resulting in alienation and loneliness. Second, these children are living with adults calling themselves parents but whom the children have not experienced as parents. Even if the children accept the natural parent as parent, they may resent the abandonment of years ago. Third, children in this scenario are grieving the loss of the primary caretaker from the formative years and most likely the person they have experienced psychologically as parent. Fourth, the natural parent may resent and react to the child's apparent lack of gratitude for the opportunity to live in the U.S. At times, parents have reacted somewhat angrily: "If he or she wants to go back, I'll send him or her back." Children in this situation must deal with the conflictual feelings of wanting to return to their country of origin and experiencing yet another perceived rejection at the hands of the natural parent. The threat of replicating early separation trauma is very real in these families, and it is at this point that such families may present for counseling.

Ethics - Counseling the Immigrant Family
The literature offers various modalities for working with families experiencing intergenerational accultural conflict (Baptiste, 1987; Gushue, 1993; Landau, 1982; Sciarra & Ponterotto, 1991; Szapocznik & Kurtines, 1993). Szapocznik, Santisteban, Kurtines, Perez-Vidal, & Hervis (1984) suggested a psychoeducational approach that they have called "Bicultural Effectiveness Training" (BET). The BET approach is unique in that it uses some of the fundamentals of family systems theory and reframes them in terms of intercultural conflict. For example, systems theory posits that symptomatic behavior serves a function for the system (Auerswald, 1981; von Bertalanffy, 1968; Breunlin, 1992; Skynner, 1981). In family counseling, that systemic perspective translates into the creation of an identified patient (IP) who is given individual blame for what is really a systemic problem (Becvar & Becvar, 1988; Boscolo, Cecchin, Hoffman, & Penn, 1987; Haley, 1976, 1980; Minuchin, 1974; Minuchin & Fishman, 1981). Szapocznik et al. (1984) suggested that culture rather than an individual be labeled as the IP, thereby removing the blame from any one member of the family and making culture responsible for creating conflicting perspectives among family members. A parent-child conflict is reframed as conflict between cultures in which each member has a point of view that is culturally determined (Szapocznik & Kurtines, 1993). The following is a possible counselor reframe in culturally sensitive family counseling:

I [counselor] do not believe that your children disrespect you. What I believe is that they are trying to give you something of value and at the same time asking you to give them something of value. I believe this something to be your different cultural understandings and appreciations.

BET encourages a different kind of interaction whereby parents and children can be given the opportunity to hear, understand, and accept the value of certain aspects of each other's culture. Parents listen and learn to appreciate from their children aspects of the dominant culture: children, on the other hand, listen and learn to appreciate their parents' nondominant culture. Parents are invited to share with their children how things were done in their native culture, and children are invited to share the customs of the dominant culture. The counselor blocks any attempt on the part of either subsystem to interrupt the other and reframes any disparaging remarks as stunting the family's growth toward biculturalism.

When working with immigrant families, intergenerational conflict can be reframed as intercultural. The task of the family counselor is to facilitate a "multiculturalism" in the family, or as Szapocznik et al. (1984) preferred: facilitate the family's transition from intergenerational dysfunction to bicultural effectiveness. Biculturally effective families have members who feel at home both In the host culture and that of the country of origin.
- Sciarra, Daniel T..; Intrafamilial separations in the immigrant family: implications for cross-cultural counseling,  Journal of Multicultural Counseling & Development; Jan 1999; Vol. 27. Issue 1.

Personal Reflection Exercise #2
The preceding section contained information about intrafamilial separations in the immigrant family.  Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Hofhuis, J., Schafraad, P., Trilling, D., Luca, N., & van Manen, B. (2021). Automated content analysis of cultural Diversity Perspectives in Annual Reports (DivPAR): Development, validation, and future research agenda. Cultural Diversity and Ethnic Minority Psychology. Advance online publication.

Smith, J. L., McPartlan, P., Poe, J., & Thoman, D. B. (2021). Diversity fatigue: A survey for measuring attitudes towards diversity enhancing efforts in academia. Cultural Diversity and Ethnic Minority Psychology, 27(4), 659–674.

Tummala-Narra, P., Claudius, M., Letendre, P. J., Sarbu, E., Teran, V., & Villalba, W. (2018). Psychoanalytic psychologists’ conceptualizations of cultural competence in psychotherapy. Psychoanalytic Psychology, 35(1), 46–59.

What is "Biracial Effectiveness Training" (BET)?
To select and enter your answer go to Test.

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